Does SHA cover the full bill at a private hospital?

Not usually. SHA pays at the published benefit tariff. Private hospitals commonly charge above that tariff. The difference between the private charge and the SHA tariff is the member co-pay, billed to you. Public and mission hospitals frequently price at or near the SHA tariff, so co-pays there are smaller or absent.

How do I know the co-pay before admission?

Ask for a written estimate from the private hospital admissions office. Cross-check the SHA benefit tariff for the same procedure or bed-day rate at sha.go.ke/benefit-tariffs. The difference is your minimum expected co-pay. Actual bills often exceed the estimate as investigations and drugs are added.

Can I stack private insurance on top of SHA?

Yes. Many corporate health plans and private insurance policies are structured to pay after SHA, or to top-up the SHA-covered portion. Present both covers at admission. The hospital typically bills SHA first, then the private cover, then invoices you for any remaining balance.

Which private hospitals accept SHA?

This changes. Faith-based hospitals are largely contracted. Some large private chains have entered and exited the SHA contract network. Do not rely on informal reports; check sha.go.ke/contracted-facilities for the current list on the day of admission. Full context: see our guide on which hospitals accept SHA.

SHA + private hospitals Kenya 2026: what you may still owe

How SHA pays a private hospital

SHA reimburses contracted facilities at the published benefit tariff for the specific service delivered. The tariff is a schedule of prices SHA is willing to pay: KES 3,360 per bed-day at Level 4, KES 4,480 at Level 6, KES 30,000 for a caesarean section, KES 10,650 per haemodialysis session, and so on across hundreds of line items [Source 1]. A public county referral hospital typically prices at that tariff; the SHA payment covers the full bill for a covered service.

A private hospital sets its own retail prices, which reflect the cost of private nursing ratios, equipment maintenance contracts, better food, private wards, and profit margins to shareholders. A retail price for a caesarean section at a top-tier private facility might be several multiples of the SHA tariff. SHA still pays only the tariff. The difference is the co-pay, and it is yours.

Where the balance can be large

Specialist consultations. A private consultant fee is set by the consultant; SHA pays the schedule rate for the consult. Difference to you.
Private-ward or single-room admissions. SHA covers a general-ward bed-day rate. A private ward or single room is typically outside the SHA benefit package (private-ward-only admissions are on the exclusion list [Source 2]) and is fully your bill unless a private policy pays.
Non-formulary drugs. Drugs outside the Kenya Essential Medicines List are excluded from SHA cover [Source 2]. Branded alternatives to covered generics are billed to you.
Special investigations. Advanced imaging or specialised diagnostics beyond the SHA per-item cap are billed to you above the SHA-paid portion.
Top-tier private admissions. An ICU stay at a top-tier private facility can generate a co-pay in six figures even where ECCIF covers the SHA-tariff portion of the ICU care.

Getting a real estimate before admission

Ask admissions for a written estimate. List the anticipated bed-days, procedures, medicines, and investigations. Every private hospital admissions office produces these.
Pull the SHA tariff line by line from sha.go.ke/benefit-tariffs. Match each estimate line to a SHA tariff item.
Compute the difference. Sum SHA tariff (which SHA pays), then subtract from the private estimate. The remainder is the minimum expected co-pay.
Ask what is excluded. Private-ward accommodation, branded drugs, special theatre supplies. Anything on the SHA exclusion list is fully yours.
Ask about deposits. Most private hospitals require a cash deposit at admission even when SHA is billed, to cover expected co-pay. Bargain in writing; get the deposit refund policy in writing.

Once admitted, the bill can drift beyond the estimate as tests are added and complications arise. Nothing you can do fully prevents that, but the estimate is your baseline for pushback.

Private-hospital participation in SHA: the pattern

The pattern of private participation matters more than any single name. We deliberately do not name specific private hospitals as accepting or refusing SHA on this page: contract status changes frequently, some large chains have publicly entered and exited the SHA network during 2024 to 2026 over tariff and payment disputes, and a family relying on an out-of-date list at admission can suffer real harm.

The general pattern is:

Faith-based hospitals are largely contracted and have been in the SHA network throughout the NHIF-to-SHA transition. Even so, verify on the day.
Mid-tier private hospitals are commonly contracted for outpatient and general ward admissions but may exclude certain high-cost admissions from their SHA contract scope.
Top-tier private hospitals have moved in and out of contracts during 2024 to 2026 over tariff disputes and unpaid claims. Even where they are contracted, retail prices sit well above SHA tariffs and co-pays are substantial. Some top-tier facilities operate a partial-SHA model: they will bill SHA for the covered portion but require a substantial cash top-up.

For the authoritative live list: sha.go.ke/contracted-facilities [Source 3]. For real-time eligibility check on your own record and a facility's ability to bill for you: eligibility.sha.go.ke. Fuller treatment: which hospitals accept SHA.

Stacking SHA with private insurance

Corporate health plans and individual private insurance policies are often written on a "secondary to SHA" basis: they pay after SHA has paid its portion. This is why premiums have adjusted since October 2024 as SHA absorbed a share of costs previously borne by private cover.

Practical mechanics at admission:

Present both your SHA member number and your private-insurance card.
Ask the hospital to bill SHA first for the covered portion, then the private insurer, then invoice you for any remainder.
Retain every claim reference, both SHA and private.
If the private insurer rejects a portion, check whether SHA should have covered more of it (in which case, appeal SHA; see how to appeal a rejected SHA claim).

If a private hospital refuses to bill SHA

Some private facilities decline to bill SHA for admissions where they anticipate SHA will pay a small fraction of the retail price. This is a commercial choice, not always a contract failure. Where the facility is on the SHA contracted list but refuses to accept SHA billing for your admission, the practical options are:

Insist on SHA billing for the SHA-covered portion, and offer to settle the estimated co-pay in cash. Written estimate first.
Escalate to the hospital administrator and cite the facility's SHA contract status.
Move to an adjacent facility that will bill SHA (a nearby public Level 5 or 6 hospital typically will). ECCIF ambulance evacuation applies if the reason for the move is emergency-driven.
File a complaint with SHA on 0800 720 601 and, if the issue is a recurrent facility pattern, with the Ministry of Health.

Full playbook: what to do when a hospital refuses SHA.

The fraud context, briefly

Public reporting for October 2024 to April 2025 puts SHA fraud losses at approximately KES 11 billion, with 31 private facilities closed for investigation and nine arrests including a former CEO. Attribute to source when citing. This context sits behind the tightened claim scrutiny and the pattern of hospitals reporting they are being offered 10 to 40% of verified claim value. From the patient side, this means expect more paperwork at admission at private facilities, and expect the facility to protect itself with larger cash deposits.

Private-admission checklist

Verify SHA active status via *147# or eligibility.sha.go.ke.
Verify facility on sha.go.ke/contracted-facilities.
Get a written admission estimate.
Match line items to SHA tariff.
Confirm your private-insurance cover coordinates with SHA.
Bargain the deposit; get the refund policy in writing.
Retain every reference number and receipt through discharge.
Do not settle a rejected-claim bill without first verifying the rejection reason.

Sources

SHA benefit tariffs: sha.go.ke/benefit-tariffs, accessed 26 August 2026.
SHA exclusions list within benefit tariffs, including private-ward-only admissions, non-formulary drugs, cosmetic procedures. Same source, accessed 26 August 2026.
SHA contracted facilities directory: sha.go.ke/contracted-facilities, accessed 26 August 2026. Interface is JavaScript-driven; verify on the day of admission.
SHA eligibility check: eligibility.sha.go.ke.
Public reporting: SHA fraud losses of approximately KES 11 billion for October 2024 to April 2025, 31 facilities closed, nine arrests including a former CEO. Attribute to source when citing.
Council of Governors reporting: counties owed KES 26.87 billion as of 31 March 2026; hospitals report being offered 10 to 40% of verified claim value. Attribute to source when citing.
SHA toll-free helpline 0800 720 601.